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Study design: Case report describing Burkholderia pickettii spondylitis in a healthy adult. Objectives: To describe this very rare form of spondylitis and to discuss some of the difficulties in the diagnosis of B. pickettii spondylitis. Setting: Department of Orthopaedic Surgery, Nayoro City General Hospital, Japan. Methods: A 48-year-old woman presented with a complaint of severe back pain radiating from the right side of her chest. Plain radiographs of the spine showed osteolytic destruction of the right side of the T10 vertebral body at T10 level, with an involvement of the pedicle. Magnetic resonance image of the spine showed a low signal intensity from the T10 vertebral body on a Tlweighted image and an increased signal intensity on T2-weighted sequence image. These lesions were enhanced when a contrast medium was used. The patient underwent open biopsy and specimens were collected through the right pedicle. Results: Diagnosis was established on the basis of direct identification of the microorganism. Histological findings were consistent with examination of B. pickettii spondylitis. Chemotherapy (intravenous cefepime and per os minocycline) resulted in complete cure. Conclusion: B. pickettii is widely distributed in aqueous sources in nature and has not previously been considered to be an aggressive pathogen towards humans. This case report will help to improve our understanding of the ecology and virulent pathogenicity of this organism. A biopsy is an essential and reliable method for the early etiologic diagnosis, which will lead to prevent the development of more severe complications such as spinal cord compression.Spinal Cord (2005) 43, 499-502.

The authors describe a case of 28-year-old man who presented with cervical myelopathy and lumbar radiculopathy due to the giant cervical pseudomeningocele extending to the lumbar spine at 10 years after previous brachial plexus injury. To evaluate the communicating tract between pseudomeningocele and subarachnoidal space, the multidetector-row helical CT with simultaneous myelography was performed preoperatively. The surgical treatment in the cervical spine included the resection of pseudomeningocele and the repair of dural defects communicating into the cyst following multi-level laminoplasty and foraminotomies. At 6 years after surgery, the significant neurologic recovery and complete obliteration of cysts in the whole spine area were maintained. This serves as the first report describing the significant neurologic recovery after the surgical treatment of giant cervical pseudomeningocele extending to the lumbar spine after previous brachial plexus injury.

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